Corner Clinic

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UC San Diego Health Experts |
June 28, 2018

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Our experts answer your questions on everything from headaches to tummy aches. This month, our experts discuss how to choose a healthy sweetener, whether or not you need to clean your ears and the best type of sunscreen.

How do I choose a healthy sweetener?Carla Salcedo, registered dietitian at UC San Diego Health

Sweeteners are typically divided into two classes: nutritive and non-nutritive. Nutritive sweeteners are natural or “real” (think table sugar) and provide calories from carbohydrates. Non-nutritive sweeteners are processed (think colored sweetener packets at the coffee bar) and provide minimal calories because they are not completely absorbed by your digestive system. These sweeteners are many times sweeter than sugar; therefore very small amounts are needed for the same sweetness.

So which one is the better option? You should always aim for adhering to the goal of 50 grams or less of added sugar daily and consuming small amounts of nutritive sweeteners may be the safest path. Using these “real” sugars in the raw forms provides a few additional nutrients, a few less calories and a bolder taste without the potential side effects of artificial sweeteners. In the world of non-nutritive sweeteners, the plant-derived stevia may be the safest and, based on information currently available, has possible health benefits.

In either case, we need to redirect our taste buds to enjoy the natural sweetness of our foods. Fruits and fruit-sweetened foods should be employed to manage a sweet tooth. The occasional use of a non-nutritive sweetener (a weekly diet soda or two) should not be of grave concern and unlikely to alter gut bacteria permanently. The consumption of a good piece of pie periodically will not increase your risks of diabetes or heart disease if your overall diet is healthy — as in eating several servings of fruits and vegetables daily.

When eating either real or artificial sugars, note the impact on your energy levels, your cravings and other effects that may suggest a need for reduction in these foods. As always, follow your own health goals and seek credible nutrition guidance from a professional Registered Dietitian/Nutritionist (RDN) to help you get started.

Should I clean my ears?Sharon Mick, nurse practitioner, Division of Head and Neck Surgery, UC San Diego Health

Ears are self-cleaning organs that don't require any manipulation with items such as Q-tips, bobby pins or pen caps. The best self-care for ears is to wash the outside of your ears with a moist washcloth followed by a dry towel. If the ear still feels wet, then air from a hair dryer can be used, making sure to hold it several inches away from your ear, so you do not burn or injure the skin.

Cerumen, or ear wax, is a normal secretion of the body and a natural part of the body's defense. It is produced by sebaceous (under the skin) glands in the outer one third of the ear canal. Secreted ear wax typically migrates outward toward the opening of the ear canal. Blockages of ear wax can occur when Q-tips or other items are used to try to clean the ears. These items can push the wax further into the canal to the point over time where it can potentially disrupt hearing. If this type of blockage becomes an issue, it is best to see your primary care provider or a specialist for removal.

You may have read about a procedure called “candling” that has been circulating on the internet as a method to clean your ears. It is not advised. It will not work to remove a wax impaction and there’s risk of hot wax dripping into the ear canal, burning the skin and/or ear drum itself, which can cause permanent damage.

In short, it’s best to leave your ears alone and let your body do the work!

What is the best type of sunscreen?
Arisa Ortiz, MD, director of Laser and Cosmetic Dermatology, UC San Diego Health

The American Academy of Dermatology recommends that everyone use a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Broad-spectrum sunscreens are important because they protect against UVA rays that can prematurely age your skin and UVB rays, which are the primary cause of sunburns and skin cancer. Water-resistant sunscreens are effective for up to 40 minutes in the water and should be reapplied after that time. Sunscreens come in lotions, creams, gels, ointments, wax sticks and sprays. They are all equally effective. Creams are best used on the face. Gels are good for hairy areas, like the male scalp or chest. Sprays are convenient to use on children, but make sure that a sufficient amount is being applied and spray outdoors so that the product is not inhaled. When applying to the face, spray the sunscreen into your hand first and then apply to avoid inhalation. Sunscreens with an SPF 30 block 97 percent of the sun's UVB rays. Higher SPFs will block slightly more than 97 percent, but no sunscreen exists that will block 100 percent of the sun's UVB rays.

People often think that "natural" sunscreens are safer, but that is misleading. As a dermatologist, I commonly see allergic reactions to supposedly natural compounds. Usually, this is because they are not properly tested. Often, it also means they provide inadequate protection from the sun. If you have sensitive or allergic skin, I recommend using a physical blocker, like zinc oxide or titanium dioxide over a chemical sunscreen. Physical blockers sit on the skin's surface and reflect the light. They are non-allergenic. Chemical sunscreens are absorbed into the skin and deactivate the sunlight.

No matter which sunscreen you prefer, the best one is the one you will use again and again. For optimal sun protection, remember to reapply, seek shade and wear protective clothing.